Sandra G. Affenito

The relationship between meal frequency and body mass index in black and white adolescent girls: more is less

Objective:To document meal frequency and its relationship to body mass index (BMI) in a longitudinal sample of black and white girls from ages 9–19 years.Design:Ten-year longitudinal observational study.Subjects:At baseline, 1209 Black girls (539 age nine years, 670 age 10 years) and 1,166 White girls (616 age nine years, 550 age 10 years) were enrolled in the National Heart, Lung and Blood Institute Growth and Health Study (NGHS).Measurements:Three-day food diaries, measured height and weight and self-reported physical activity and television viewing were obtained at annual in-person visits.Results:Over the course of the study, the percentage of girls eating 3+ meals on all 3 days was reduced by over half (15 vs 6%). Participants who ate 3+ meals on more days had lower BMI-for-age z-scores. Black girls, but not white girls, who ate 3+ meals on more days were less likely to meet criteria for overweight.Conclusion:Meal frequency was related to BMI and should be considered when developing guidelines to prevent childhood overweight.

What Mediates the Relationship Between Family Meals and Adolescent Health Issues

OBJECTIVE To determine whether the frequency of family meals in childhood is associated with positive health outcomes in adolescence through the mediating links of increased family cohesion and positive coping skills. DESIGN Data were obtained from the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS), a 10-year longitudinal study of 2,379 black and white girls assessed annually from ages 9-19. The mediational analysis framework of H. C. Kraemer and colleagues (2001) was used to test the hypothesis that the frequency of family meals in childhood (Study Years 1 and 3) would be related to health outcomes (Study Year 10) through the mediating links of family cohesion and coping skills (Study Years 7/8), after adjusting for baseline (Year 1) demographics as well as previous levels of the outcome variables (Years 5/6). MAIN OUTCOME MEASURES Several measures of adolescent health variables were included as outcome measures. These included the Perceived Stress Scale, three Eating Disorders Inventory subscales (drive for thinness, body dissatisfaction, and bulimia), number of days of alcohol and tobacco consumption, and engaging in extreme weight control behaviors (e.g., self-induced vomiting). RESULTS More frequent family meals in the first 3 study years predicted greater family cohesion and problem- and emotion-focused coping in Years 7 and 8. Family cohesion mediated family meals and risk of smoking in Year 10. Problem-focused coping mediated family meals and both stress and disordered eating-related attitudes and behaviors in Year 10. CONCLUSION Eating together as a family during childhood may have multiple benefits in later years.

Subclinical and Clinical Eating Disorders in IDDM Negatively Affect Metabolic Control

OBJECTIVE To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM. RESEARCH DESIGN AND METHODS Ninety women with IDDM (18–46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R). RESULTS Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c. CONCLUSIONS HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.

Night Eating: Prevalence and Demographic Correlates

Objective: To examine the prevalence and correlates of night eating, the core behavioral symptom of night eating syndrome among adolescents and adults, using two public access survey databases of nationally representative samples.

Longitudinal patterns of breakfast eating in black and white adolescent girls

Objective: The objective was to describe the pattern of breakfast eating over time (“breakfast history”) and examine its associations with BMI and physical activity.

Development and validation of a screening tool to identify eating disorders in female athletes

OBJECTIVE To develop and validate a screening tool to identify eating pathology in women athletes. DESIGN Three cross-sectional subject groups were established: college women athletes diagnosed with eating disorders; college women athletes without eating pathology; college women who did not participate in athletics but were diagnosed with an eating disorder. The Female Athlete Screening Tool (FAST), and 3 valid psychometric measures were administered to subjects in all groups. Internal reliability, discriminant and concurrent validity were established. SUBJECTS/SETTINGS Women college students between the ages of 18 and 23 years (n=41) from the University of Connecticut and St Joseph College were recruited. The athletes were screened for eating disorders by a sports medicine team. STATISTICAL ANALYSIS Cronbachs alpha, one-way analysis of variance, and correlation analyses. RESULTS Reliability analysis indicated a high internal consistency of the FAST (Cronbachs alpha = 0.87). Athletes with eating disorders scored significantly higher on the FAST as compared with athletes without eating pathology and nonathletes with eating disorders (P<.001), which demonstrated discriminant validity. Correlation analyses showed that the FAST was strongly correlated to the Eating Disorder Examination-Questionnaire (0.60, P<.05) and Eating Disorder Inventory (0.89, P<.001). APPLICATIONS/CONCLUSIONS Early detection of eating disorders can help prevent the onset or severity of a clinical eating disorder. By using the screening tool that has been validated for use in women athletes, dietetic professionals can quickly identify those athletes who need assistance with their aberrant eating habits.

The Relationship of Ready-to-Eat Cereal Consumption to Nutrient Intake, Blood Lipids, and Body Mass Index of Children as They Age through Adolescence

OBJECTIVE To examine sex differences and longitudinal changes in ready-to-eat (RTE) cereal and breakfast consumption in the Dietary Intervention Study in Children, and the relationship between RTE cereal intake with nutrient intake, blood lipids, and body mass index (BMI). DESIGN Secondary analyses based on data from Dietary Intervention Study in Children, a randomized, controlled, multicenter, clinical trial with five sets of three 24-hour recalls. SUBJECTS/SETTING Children (n=660) from six clinics aged 8 to 10 years at study entry. Participants had serum low-density lipoprotein cholesterol levels between the 80th and 98th percentiles for age, and were followed for a mean of 7.5 years. INTERVENTION Children were randomized to a total fat- and saturated fat-modified dietary intervention or usual care. STATISTICAL ANALYSES Frequency of RTE cereal and breakfast consumption was examined by sex and age. Mixed models by sex were used to examine the relationship of RTE cereal consumption to average daily intake of nutrients, blood lipids, and BMI. RESULTS For all children, RTE cereal and breakfast consumption declined with age. Boys consumed RTE cereal more often compared with girls. Except for energy, RTE cereal consumption was positively associated with all measures of nutrients for both sexes. In boys, higher RTE cereal consumption was associated with lower total and low-density lipoprotein cholesterol levels and lower BMI. CONCLUSIONS Food and nutrition professionals should continue to educate youth and their parents on the nutritional benefits of routinely eating RTE cereal.

What's love got to do with it? Family cohesion and healthy eating behaviors in adolescent girls

OBJECTIVE To examine the association between family cohesion and behaviors linked to health or overweight in adolescents. METHOD Cross-sectional analyses of family cohesion and eating behaviors of 2,379 girls (followed from ages 9-19) who participated in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS). Height and weight measurements were obtained on an annual basis. Family cohesion was measured by the Family Adaptability and Cohesion Evaluation Scale (FACES) III. Food diaries were used to assess frequency of breakfast consumption and intake of milk, soda, fruits, and vegetables. RESULTS Family cohesion was significantly associated with less soda intake and higher rates of breakfast consumption. Ingestion of milk, fruits, and vegetables was predicted by family cohesion at the trend level. CONCLUSION Understanding the role of familial factors in adolescent eating behaviors is an important research priority. Strengthening family cohesion may be a valuable goal toward promoting the health of adolescents, increasing breakfast eating and decreasing soda consumption.

Exploring the typology of night eating syndrome.

OBJECTIVE There is an ongoing debate about the definitions and clinical significance of night eating syndrome (NES). This study explored potential subtypes based on night eating patterns and features reported to be associated, with NES in a representative community sample of 8,250 individuals aged 15-39 years. METHOD Latent class analysis was used to identify NES subtypes among 2,068 participants who reported night eating behavior. RESULTS A four-class solution was judged best. Two classes appear to characterize individuals who eat very late or eat a large proportion of their daily intake after 7 pm, and two other classes are characterized by high rates of depressive symptoms. Results do not support an association between night eating and obesity in young adults. Late night eating is associated with high caloric intake, high sodium intake, and low protein intake. CONCLUSION Evidence supports the validity of a definition of NES based on eating very late at night.

Ethnic differences in food sources of vitamin D in adolescent American girls: the National Heart, Lung, and Blood Institute Growth and Health Study ☆

The National Heart, Lung, and Blood Institute Growth and Health Study was a 10-year longitudinal study of the development of obesity and cardiovascular disease risk factors (including dietary, psychosocial, environmental, and others) in 2379 African American and white girls who were 9 or 10 years old at study entry. Current studies have documented a high prevalence of vitamin D insufficiency among healthy children, adolescents, and young adults in the United States, especially among low-income, black, and Hispanic children (defined as serum 25-hydroxyvitamin D concentrations of <20 ng/mL). Although the main source of vitamin D is direct exposure of the skin to ultraviolet rays from sunlight, certain foods contribute vitamin D including fortified milk, meat, eggs, oils, and fortified cereals. Vulnerable subgroups that are especially at risk for inadequate intakes of vitamin D include teenage girls and women. Research providing the prevalent food sources of vitamin D, especially in the diets of both white and African American female adolescents is limited. The purpose of this study is to document food sources of vitamin D reported by this biracial young cohort and compare potential ethnic or other differences that could enhance tailored dietary interventions that are particularly relevant to this vulnerable population subgroup.